Hoffmann's phenomenon : increased excitability to electrical stimulation
in the sensory nerves; the ulnar nerve is usually tested
break-off phenomenon : a state of disconnectedness or unreality
experienced by high-altitude pilots. Its symptomatic sensations are apparently
indescribable in understandable physical terms, but the condition could
be the result of a loss of all the physical sense perceptions.
cacosmia : a parosmia consisting of bad smell
not related to exposure to a specific odor, or associated with olfactory
stimuli usually considered to be pleasant.
true or subjective cacosmia
Aetiology :
olfactory neuritis due to endogenous or exogenous toxics (as above)
anosmia / anosphresia / olfactory anesthesia
(partial or total, transient or permanent, unilateral or bilateral) : absence
of the sense of smell
hemianosmia : anosmia in one of the nostrils.
anosmia gustatoria : the loss of the power to smell foods.
preferential anosmia : lack of ability to sense certain odors only.
anosmia respiratoria : loss of smell due to nasal obstruction.
Epidemiology : our sense of smell also weakens
naturally with age, causing many elderly people to lose their appetite
and become malnourished. Even among those without disorders, sensitivity
to smell varies widely between people. Women are generally ten times more
sensitive to smell than men, and pregnant women in particular have a heightened
sense of smell
Aetiology :
congenital forms
deficitary development of olfactory bulb or nervous centres
Experimental animal models : Kv1.3 channel
gene-targeted deletion produces "super-smeller mice" with altered glomeruli,
interacting scaffold proteins and biophysics. Ultrasensitive humans might
have less of the Kv1.3 protein. The protein might work by increasing the
number of glomeruli in the brain - specialized regions that focus signals
from the nose and relay them on to the part of the brain that identifies
smells.
Web resources : Anosmia
Foundation
Laboratory examinations :
Proetz test : use of a series of substances each in 10 different
concentrations in a liter of petroleum of specific gravity 0.880, to determine
the least concentration at which the substance can be recognized, termed
olfactory
coefficient or minimal identifiable odor.
Elsberg's test : a method of testing the functioning of the sense
of smell; variations in function or in rate of fatigue may be used to distinguish
between intracerebral and extracerebral tumors or other lesions
orbital floor syndrome / Dejean's syndrome : exophthalmos,
diplopia,
and anesthesia in the areas innervated by the trigeminal nerve, occurring
with a lesion in the floor of the orbit.
orbital rhabdomyosarcoma
: rhabdomyosarcoma in the orbit and surrounding structures, usually superior
to the globe; the most common types are embryonal
and alveolar. It may affect patients
of any age and is the most common primary malignant orbital tumor in children.
orbitalmucosal
melanoma
: an encapsulated, circumscribed mass. The tumor is built up of fusiform
and spindle-shaped cells containing black pigmentation, with very few mitoses
and without necrosis.
orbital pseudotumor
: a distinctive, chronic inflammatory reaction in the orbital tissues of
the eye, of unknown etiology, that may closely resemble a neoplasm and
often becomes bilateral. Symptoms include exophthalmos
and congestion of the lids with edema. When limitation of ocular motility
also occurs, it is sometimes called orbital myositis
ablepharia / cryptophthalmos : a developmental
anomaly in which the skin is continuous over the eyeball without any indication
of the formation of eyelids.
chalazion / meibomian or tarsal cyst : a
small circumscribed granuloma of the eyelid formed by encystment and retention
of secretions of the meibomian gland and sometimes accompanied by inflammation.
More common in the upper eyelid, it may cause astigmatism.
Therapy : surgery
symblepharon : partial or total adhesion
of palpebral and bulbar conjunctivae
ankyloblepharon : adhesion between
the margins of the eyelids
blepharoptosis / palpebral ptosis
: drooping of the upper eyelid
Symptoms & signs : the lid may droop only
slightly, or it may cover the pupil entirely. In some cases, ptosis can
restrict and even block normal vision. Compensatory neck extension and
corrugation of frontal muscle.
Symptoms & signs : compensatory upward
head rotation; Kiloh-Nevin syndrome (ocular myopathy in patients
with ptosis and progressive external
ophthalmoplegia)
Therapy : blepharoplasty
blepharochalasis / dermatolysis palpebrarum
: relaxation of the skin of the eyelid
Aetiology : Ascher syndrome (blepharochalasis
occurring with goiter (adenoma of the thyroid) and redundancy of the mucous
membrane and submucous tissue of the upper lip)
Therapy : blepharoplasty
trichiasis : a condition of ingrowing hairs
about an orifice, or of ingrowing eyelashes
districhiasis : > 1 cilium growing from
a follicle
polystichia : the presence of 2 or more
rows of eyelashes upon a lid
distichiasis the presence of 2
rows of cilia on one eyelid
tristichia : the existence of 3 rows of
eyelashes
tetrastichiasis : an extremely rare
condition in which there are 4 rows of eyelashes
madarosis / milphosis : loss of the eyelashes
or of the hair of the eyebrows
lacrimal abscess : one in or around the lacrimal sac
lacrimal fistula / dacryosyrinx : an abnormal passage communicating
with the lacrimal sac or duct.
canaliculitis / dacryosolenitis : inflammation
of a lacrimal duct
dacryostenosis : a blocked tear duct
dacryocystostenosis : narrowing of the lacrimal sac
dacryocystorhinostenosis : narrowing of the duct leading from the
lacrimal sac to the nasal cavity
dacryoadenalgia / dacryadenalgia : pain in a lacrimal gland
dacryocystalgia / dacrycystalgia : pain in a lacrimal sac.
dacryagogatresia / lacrimal duct atresia :
dacryocanaliculitis : inflammation of the lacrimal ducts.
dacryocystectasia : dilatation of the lacrimal sac.
dacryohemorrhea : the discharge of tears mixed with blood.
dacryopyosis : suppuration of the lacrimal sac and duct.
dacryorrhea : an overabundant flow of tears.
dacryopyorrhea : the discharge of tears mixed with pus
dacryoblennorrhea : mucous discharge from the lacrimal ducts, as
in chronic dacryocystitis.
dacryocystoblennorrhea : a chronic catarrhal inflammation of the
lacrimal sac, with constriction of the lacrimal duct.
dacryocystocele / dacryocele : hernial protrusion of the
lacrimal sac
dacryocystoptosis : prolapse or downward displacement of the lacrimal
sac.
dacryohelcosis / dacryelcosis : ulceration of the lacrimal
sac or lacrimal duct.
dacryolithiasis : the presence of calculi (dacryolith) in
the lacrimal sac or duct.
dacryoma : a tumor-like swelling caused by obstruction of the lacrimal
duct.
dacryops : 1. a watery state of the eye. 2. distention of
a lacrimal duct by contained fluid.
dacryosinusitis : inflammation of the lacrimal duct and ethmoid
sinus.
Symptoms & signs :
epiphora / illacrimation: abnormal
overflow of tears down the cheek
mucocele : dilatation of a cavity with accumulated
mucous secretion.
Laboratory examinations :
Schirmer's test 1 : a strip of absorbing
paper (35 x 5 mm) is placed in the lateral portion of lower fornix. After
5' :
> 10 mm are wet : lachrymation is effective
10 < x < 5 mm : mild impairment
< 5 mm : lachrymation deficit
Jones test / basal secretion test : as
above but 7' after instillation of topical anaesthetic
Schirmer's test 2 : as above plus stimulation of reflex secretion
moving a nasal tampon for 2'
Schirmer's test 3 : as above plus stimulation of reflex secretion
with sunlight
break up time (BUT) test : after instillation
of 2 mL fluorescein 1%, eyelids are forced in open position and fluorescence
disappears under slit-lamp before 10" (hypersecretion)
or after 18" (xerophthalmia)
Bowman probeis inserted vertically in the lower punctus
for exploring and clearing an obstruction of the tear duct
soft stop marks a canalicular obstruction
hard stop marks sudden contact with medial wall of lacrimal sac,
suggesting a downstream obstruction
dacryocystography
fibroendoscopy
aspecific ocular symptoms
aniseikonia : a condition in which the
image sizes in each eye are different, leading to difficulties in achieving
single vision.
ocular crisis : a sudden attack of intense pain in the eyes, with
lacrimation, photophobia, etc.
Laboratory examinations : glare testing
: a procedure for assessing a patient’s vision in the presence of a bright
light source to determine whether sensitivity to glare is contributing
to visual symptoms.
photalgia : ocular pain caused by light
hemiopalgia : pain in one side of the head and in one eye
bradyopsia :
Aetiology : mutations that cripple an
enzyme in the eye
Pathogenesis : difficult adjust to bright
light
Therapy : wearing sunglasses indoors
autosomal dominant compelling helio-ophthalmic outburst
(ACHOO) syndrome / sun-sneeze
response : an inherited
disorder in which sensory impulses from the optic nerve spill over into
the trigeminal nerve in the nose. A strong visual signal causes itching
in the nostrils, which triggers the sneeze reflex.
Epidemiology
: prevalence = 18-35%
eye strain / asthenopia :
weakness or easy fatigue of the visual organs
Aetiology :
accommodative asthenopia : asthenopia due to strain of the ciliary
muscle.
spectacle blur : temporary blurred
vision upon switching from contact lenses to eyeglasses.
torpor retinae : a condition in which the retina is excited to action
only by stimuli of considerable luminous power
optical allachesthesia / visual allesthesia : a condition in which
visual images are transposed from one half of the visual field to the other,
either vertically or horizontally
polyopia : the condition in which one object
appears as 2 or more objects.
polyopia monophthalmica : a condition in which an object looked
at by one eye appears double.
diplopia / double vision / binocular polyopia
:
a visual disorder due to unequal action of the eye muscles causing 2 images
of a single object to be seen
monodiplopia / monocular diplopia : double
vision in one eye only (it appears when one eye is closed)
binocular diplopia
: a visual disorder
due to unequal action of the eye muscles causing 2 images of a single object
to be seen. It disappears when one eye is closed
crossed diplopia : the false image
forms toward the side opposed to the lesion
homonymous diplopia : the false
image forms in the same side of the lesion
Aetiology :
defective eye alignment : alterations of ocular muscles (miositis, neoplastic
infiltration, thyroid eye
disease, orbital
fractures
=> restrictive syndrome)
cyclopia : any developmental anomaly characterized
by a single orbit; the globe may range from absent or rudimentary to apparently
normal or duplicated, and the nose may be absent or present as a tubular
appendage (proboscis) superior to the orbit.
ocular or orbital hypertelorism
: a condition characterized by abnormal increase in the interorbital distance,
often associated with cleidocranial or craniofacial
dysostosis,
and occasionally accompanied by mental deficiency
exophthalmia / exophthalmos / exophthalmus
/ proptosis / exorbitism : abnormal
forward protrusion of the eyeball (> 22 mm between parallel transverse
lines passing from lateral angle of the orbit and cornea, respectively;
> 2 mm difference between the 2 eyes)
thyroid-associated ophthalmopathy
/ dysthyroid ophthalmopathy or orbitopathy : the ocular changes associated
with thyroid dysfunction, including endocrine exophthalmos, malignant exophthalmos,
and infiltrative ophthalmopathy
Graves'
disease
(Graves' ophthalmopathy or orbitopathy) (90%)
Progression : fulminating course in 5%
Therapy : external
beam radiotherapy (EBRT);
GR
agonists;
decompression => muscular surgery is required if compression of optic nerve
or corneal ulcers occur
nystagmus / nystaxis (Ny) : involuntary
rapid and repetitive movement of the eyes during fixation
Direction which provokes nystagmus :
degree 1 if it is provoked only in the direction of the fast component
degree 2 if it is also noted in forward gaze
degree 3 if nystagmus is present in all directions of gaze
Plane in which nystagmus occurs :
unidirectional nystagmus
caloric tests hypoactive or absent => peripheral origin and quick component
toward the uninvolved ear.
caloric tests are normal => central origin
The nystagmus is usually the strongest, and often only present, when gaze
is directed toward the side of the quick component (first degree). Direction
is named according to direction of the rapid eye
movement (fast component / tachynystagmus).
horizontal or lateral
nystagmus (common) : nystagmus in which the movement of the eyes is
from side to side.
right nystagmus: fast phase rightward
left nystagmus: fast phase leftward
rotatory nystagmus : nystagmus
in which the movement is about the visual axis.
vertical nystagmus : an up-and-down
movement of the eyes.
downbeat nystagmus: fast phase downward, occurring in lesions
at the cervicomedullary junction and opioids
poisoning
upbeat nystagmus : fast phase upward, occurring in lesions of the
vermis cerebelli.
see-saw nystagmus : that in which one eye moves up as the other
moves down.
oblique nystagmus (rare)
multidirectional nystagmus is suggestive of central involvement
(i.e., a lesion anywhere in the brain). Most often, however, it results
from a posterior fossa lesion where the bulk of the vestibulocerebellar
units are located. The quick component is usually permanent and toward
the side of the lesion. True vertigo is less frequent, and ataxia
may be evident in central lesions.
Proper evaluation calls for observation of the eyes in the right, left,
upward, downward, and primary positions.
Rhythm :
jerk, jerky, resilient or rhythmical
nystagmus : nystagmus which consists of a slow movement in one direction,
followed by a rapid return movement in the opposite direction
central nystagmus : due to a lesion somewhere in the neurologic
pathways regulating gaze.
periodic alternating nystagmus : a rare form with rhythmic changes
in amplitude and direction and with intervals of quiet between periods.
convergence nystagmus : a rhythmic oscillation of the eyes, in which
they have a rapid adduction movement relative to each other alternating
with a slow abduction movement; usually caused by a tumor of the aqueduct
of Sylvius, third ventricle, or midbrain. It is often accompanied by retraction
nystagmus.
arrhythmic nystagmus
anarchic nystagmus
Aetiology :
congenital hereditary
nystagmus : nystagmus usually present at birth, usually central, horizontal
and pendular, but occasionally jerky and pendular; the nystagmus may be
caused by or associated with optic atrophy, coloboma, albinism, bilateral
macular lesions, congenital cataract,
severe astigmatism, and glaucoma.
acquired nystagmus
spontaneous nystagmus : that
occurring without specific stimulation of the vestibular system
Aetiology :
aural, labyrinthine or vestibular
nystagmus : jerky nystagmus due to absolute
or relative (as in labyrinthitis) hyperfunction
of a labyrinth causing disturbance of the vestibular system. After 2 weeks
of left labyrinthine and directional prevalences, 1 weeks of pure left
prevalence follows and then other 2 weeks of left labyrinthine prevalence
accompanied by right directional prevalence (due to recovery or contralateral
disease), eventually passing the Stock-Modena threshold and causing
a contralateral spontaneous nystagmus. Pure directional prevalence is caused
by central lesions or otolithic system lesions (utricule > saccule). The
slow phase is directed toward the affected side.
voluntary nystagmus : rapid rhythmic eye movements, up to 80 a second,
that can be produced at will by some normal individuals.
pendular, oscillating, undulatory or vibratory nystagmus : nystagmus
in which the oscillations of the eyes have an equal rate, amplitude, direction,
and type of movement
miner's nystagmus : an occupational disease of coal miners consisting
of abnormal eye movements associated with other signs and symptoms; it
is considered by some to be related to poor lighting and by others as a
functional disorder.
amaurotic or ocular nystagmus
: nystagmus in the blind or in those with central scotomas. Slow and fast
phases have the same velocity.
amblyopic nystagmus : nystagmus due to any lesion interfering with
central vision.
paretic nystagmus : a false nystagmus occurring when there is a
weakness of the ocular muscles.
gaze nystagmus : nystagmus made apparent by looking to the right
or to the left.
gaze paretic nystagmus : a form of gaze nystagmus seen in patients
recovering from CNS lesions; the eyes fail to stay fixed to the affected
side with a cerebral or pontine lesion. If the defect is in vertical gaze
it usually signifies a lesion in the pretectal area.
Laboratory examinations : Bartels eyeglasses
with biconvex 20 D lenses (if a light source is added to prevent fixation
nystagmusthey
are a.k.a. Frenzel eyeglasses). Look for nystagmus in median and
both lateral deviations (< 45° to prevent end-position
nystagmus / pseudonystagmus).
If it doesn't worse it probably has central origin.
disjunctive nystagmus : nystagmus in which the eyes swing toward
and away from each other.
dissociated nystagmus : nystagmus in which the movements in the
2 eyes are dissimilar.
retraction nystagmus / nystagmus
retractorius : a spasmodic retraction of the eyeball backward into
the orbit, occurring on attempted movement of the eye
Symptoms & signs : Bard's sign
: in organic nystagmus the oscillations of the eye increase as the patient's
attention follows the finger moved alternately from one side to the other;
but in congenital nystagmus the oscillations disappear in like condition.
opsoclonus / opsoclonia : a condition characterized
by nonrhythmic horizontal and vertical oscillations of the eyes (saccadomania).
If oscillations are only horizontal it is named ocular flutter.
nanophthalmos
: microphthalmos in an eye that is otherwise normal. It is a rare disorder
of eye development characterized by extreme hyperopia (farsightedness),
with refractive error in the range of +8.00 to +25.00 diopters. Because
the cornea and lens are normal in size and shape, hyperopia occurs because
insufficient growth along the visual axis places these lensing components
too close to the retina and the eye is prone to angle-closure glaucoma.
Nanophthalmic eyes show considerable thickening of both the choroidal vascular
bed and scleral coat, which provide nutritive and structural support for
the retina. Thickening of these tissues is a general feature of axial hyperopia,
whereas the opposite occurs in myopia. Recessive nanophthalmos has been
maped to a unique locus at 11q23.3 and identified 4 independent mutations
in membrane
frizzled-related protein (MFRP), a gene that is selectively expressed
in the eye and encodes a protein with homology to Tolloid proteases and
the Wnt-binding domain of the Frizzled transmembrane receptors. This gene
is not critical for retinal function, as patients entirely lacking MFRP
can still have good refraction-corrected vision, produce clinically normal
electro-retinograms, and show only modest anomalies in the dark adaptation
of photoreceptors. MFRP appears primarily devoted to regulating axial length
of the eye. It remains to be determined whether natural variation in its
activity plays a role in common refractive errorsref.
tetranophthalmos / tetrophthalmos : a fetus having 4 eyes
toxic anterior
segment syndrome (TASS)ref
is a potentially irreversible eye injury which occurs when a contaminant,
such as endotoxin, enters the anterior segment of the eye during surgery
and causes an inflammatory reaction. FDA recalled some contaminated products
on Feb 13, 2006ref
: an estimated 1 million units of BSS products were distributed between
Dec 2003 and Dec 2005. The BSS products subject to the recall order were
manufactured by Cytosol Laboratories, Inc. for distribution under 3 labels
:
"AMO Endosol" distributed by Advanced Medical Optics, Inc. (AMO), Santa
Ana, Calif.;
"Cytosol Ophthalmics" distributed by Cytosol Ophthalmics, Lenoir, NC; and
"Akorn" distributed by Akorn, Inc., Buffalo Grove, Ill.
It is important to differentiate TASS from true infectious endophthalmitis,
because the treatments are completely different -- and the treatment for
one isn't appropriate for the other. Symptoms for the 2 conditions may
overlap, making diagnosis difficult. In fact, surgeons often initially
treat TASS as infectious endophthalmitis. Here are some pointers for separating
the 2 :
early onset: TASS usually is seen soon after surgery -- later the same
day or the next. Infectious endophthalmitis, in contrast, most commonly
shows up 3 to 4 days postoperatively.
corneal edema: with TASS, patients complain of pain and blurred vision,
and the biggest hallmark is profound limbus-to-limbus corneal edema.
The limbus is the edge between the cornea and the sclera (the white part
of the eye). Some edema will occur with endophthalmitis, but typically
not diffuse limbus-to-limbus corneal edema. Edema after surgery is specific
to areas of trauma, so it tends to be near the wound or opposite the wound,
but some areas are not affected; not so with TASS.
inflammation: on ophthalmological examination, TASS patients have a marked
increase in inflammation in the anterior segment. An increased in the number
of white blood cells and sometimes even a hypopyon (pus on the anterior
chamber of the eye between the cornea and the iris) can be seen.
fixed pupil: TASS impairs the iris sphincter function, and the pupil tends
to be fairly dilated and does not react well to light.
high intraorbital pressure (IOP): TASS also affects the trabecular meshwork,
a network of fibers involved in the drainage of the aqueous humor of the
eye and located at the iridocorneal angle between the anterior chamber
of the eye and the venous sinus of the sclera. In endophthalmitis, IOP
usually is not elevated. A pressure of 40-70 mmHg is much more likely with
TASS.
In a toxic reaction such as TASS, the inflammation will stabilize or even
get slightly better a few hours later. If it is infectious, signs will
get a little worse. If any hint that an infectious process is occurring
early, vitreous fluid aspiration and culture should be immediately done
and antibiotics begun. If it is TASS, the patient should be treated with
a topical corticosteroid every hour and a nonsteroidal 4 times a day. At
1 to 3 weeks, TASS may still appear inflamed, but the eye still may recover
nicely if treated properly. If it still looks significantly inflamed at
6 weeks, however, further improvement is not likely to occur. Severe TASS
can cause substantial damage such as permanent damage to the corneal endothelium;
profound cystoid nonresolving macular edema; a permanently dilated fixed
pupil; and permanent damage to the trabecular meshwork, leading to resistant
glaucoma that requires multiple surgical procedures. Milder cases of TASS
get better in a couple of weeks without treatment, so it is likely that
cases are missed.
pseudoexfoliation syndrome
(PEX) is an age-related condition, which may cause open-angle
glaucoma and has increasing interest since it seems to affect additional
human tissues, i.e., cardiovascular tissue, skin, and still lacks elucidated
pathogenesis. Collagen type IX and HNK-1 epitope have been considered characteristic
constituents of the aqueous humour of PEX patients, since their amounts
were increased in PEX aqueous humour compared to normal eyes. It has been
proposed that the initial manifestations of PEX syndrome occur in conjunctiva
: collagen type IX and HNK-1 epitope were present in tears, the amount
of the former being increased 2.7 times compared to normal (P<0.05),
surprisingly high as compared with total protein or lysozyme activity in
tears, which were found to be increased in PEX patients about 25% with
no statistical differences (P approximately 0.4). The results suggest the
possible use of tears' collagen type IX for the diagnosis of PEX syndromeref
diseases of the conjunctiva
conjunctivitis / pink eye (usually
associated to keratitis
=> keratoconjunctivitis)
rarely, gram-negative enteric organisms may be implicated (Weiss AH. Conjunctivitis
in the neonatal period (ophthalmia neonatorum). In: Long SS, Pickering
LK, Prober CG, editors. Principles and practice of pediatric infectious
diseases. 2nd ed. New York: Churchill Livingstone; 2003:486–90) :
Escherichia
coli
=> acute membranous conjunctivitis in immunocompromised hosts
monolateral granulomatous conjunctivitis / Parinaud's
oculoglandular syndrome (POGS) : a general term applied to conjunctivitis,
most often unilateral, usually of the follicular type, followed
by tenderness and enlargement of the preauricular lymph nodes
Staging : keratitis
punctata => subepithelial opacities around ulcers => corneal infiltrates
Symptoms & signs : pain, photophobia,
edema, and generation of pseudomembranes, lymphadenopathy, fever.
The acute phase of EKC is usually over within 2 weeks, but corneal opacities
may remain for months or even years.
Therapy : 5-iododeoxyuridine, acyclovir,
800 mg antibacterials every 4 hrs (topical => systemic if severe keratitis)
allergic conjunctivitis => mucinous exudate and cobblestone conjunctivitis
/ giant papillary
conjunctivitis (GPC) : inflammation of the tarsal conjunctiva, characterized
by large raised bumps
toxic conjunctivitis => aqueous exudate and follicular conjunctivitis
hop eye : conjunctivitis in hop pickers caused by irritation from
the spinelike hairs of the hop plant
Klieg eye / cinema eye : a condition marked by conjunctivitis, edema
of the eyelids, lacrimation, and photophobia
due to exposure to intense lights (Klieg lights)
chalkitis : inflammation of the eyes caused by rubbing the eyes
after the hands have been used on brass.
Symptoms & signs : chemosis (edema
of the conjunctiva), conjunctival injection (congestion of blood
vessels at fornices), lacrimation, sensation of foreign body, photophobia Laboratory examinations : culture of conjunctival
exudate
Therapy : decongestants
subconjunctival or conjunctival
hemorrhage (SCH) / hyposphagma
: a rupture of a conjunctival blood
vessel that allows blood to flow under the tissue and produces a bright-red
flat area on the conjunctivaref
nonaccidental trauma should be considered in the differential diagnosis
of bilateral isolated subconjunctival hemorrhages in infants especially
if associated with facial petechiae. These isolated subconjunctival hemorrhages
may be part of the traumatic asphyxia syndrome caused by severe, prolonged
compression of the child's chest and upper abdomen. Appropriate assessment
includes a complete ophthalmic and pediatric examination as well as hematological
testing and imaging studies. If the coagulation profile and initial imaging
studies are normal yet there remains a high suspicion of abuse, an immediate
nuclear scan or a repeat skeletal survey or chest film 2 weeks later is
indicatedref.
Perthes syndrome or traumatic asphyxia is a condition characterised by
subconjunctival hemorrhage, cervicofacial petechiae and cyanosis caused
by severe compression of the chest. Diagnosis is made by history and clinical
examination. Associated injuries such as intrathoracic or abdominal lesions
can be life-threatening and must be strictly assessedref
primary conjunctival amyloidosisref1,
ref2,
ref3,
ref4
(usually diagnosed histologically instead of clinically. Evaluation for
systemic diseases is advised, though the results of the examination are
almost always negative)
homo- and heterozygosity for factor XIII A-chain Val34Leu SNPref1,
ref2
secondary to hypersympathetic state after a small diencephalic hemorrhageref
pinguecula / pinguicula : a yellowish spot
of proliferation on the bulbar conjunctiva near the sclerocorneal junction,
usually on the nasal side; seen in elderly people.
pingueculitis : inflammation of a pinguecula
pterygium : an abnormal triangular fold
of membrane, in the interpalpebral fissure, extending from the conjunctiva
to the cornea, being immovably united to the cornea at its apex, firmly
attached to the sclera throughout its middle portion, and merged with the
conjunctiva at its base
pseudopterygium : conjunctival scar
attached to the cornea
Bitot's spots : superficial, foamy gray,
triangular spots on the conjunctiva, consisting of keratinized epithelium;
they are associated with hypovitaminosis
A.
Epidemiology : the changing incidence
patterns coincide with those seen in cutaneous melanoma, suggesting a possible
link to a sunlight-related etiology
Aetiology : primary acquired conjunctival
melanosis (PAM)
hydrocystoma are unusual cystic tumors
that can affect the conjunctiva and eyelid. When they appear pigmented
and rapid in onset, it is important to differentiate them from malignant
tumors, such as melanoma
conjunctival squamous
cell carcinoma
pigmented conjunctival squamous cell carcinoma
diseases of tunica fibrosa
diseases of sclera
congenital malformations
of sclera
generalized thinning (blue
sclera : a condition of unusual blueness of the sclera due to transparency
of uvea; it is normal in infants, but is also a prominent feature of osteogenesis
imperfecta, and is seen in certain other abnormalities associated with
osteomalacia
and osteosclerosis)
nodular scleritis : that marked
by localized dark blue patches in the anterior portion of the sclera, resulting
from the choroid being visible through a translucent sclera.
scleromalacia perforans /
scleritis necroticans / necrotizing scleritis : degeneration and thinning
(softening) of the sclera, occurring in patients with rheumatoid
arthritis (RA)
nodular necrotizing scleritis
scleral granuloma
Symptoms & signs : sclerectasia
Localizations :
annular scleritis : scleritis occurring in a ring around the limbus
of the cornea.
anterior scleritis : inflammation of the sclera adjoining the limbus
of the cornea.
brawny or gelatinous scleritis : a virulent, usually bilateral scleritis
involving a thickening of the periphery of the cornea
posterior scleritis : scleritis involving the posterior sclera,
the vagina bulbi, and the underlying retina and choroid
scleral ectasia / sclerectasia / sclerectasis
:
a bulging out of the sclera.